Provision of postpartum care to women giving birth in health facilities in sub-Saharan Africa: A cross-sectional study using Demographic and Health Survey data from 33 countries.

BACKGROUND: Postpartum care has the potential to avert a substantial proportion of maternal and perinatal mortality and morbidity. There is a crucial gap in understanding the quality of postpartum care for women giving birth in health facilities in low- and middle-income settings. This is particularly the case in sub-Saharan Africa (SSA), where the levels of maternal and neonatal mortality are highest globally despite rapid increases in facility-based childbirth. This study estimated the percentage of women receiving a postpartum health check following childbirth in a health facility in SSA and examined the determinants of receiving such check. METHODS AND FINDINGS: We used the most recent Demographic and Health Survey (DHS) conducted in 33 SSA countries between 2000-2016. We estimated the percentage of women receiving a postpartum check by a health professional while in the childbirth facility and the associated 95% confidence interval (CI) for each country. We analyzed determinants of receiving such checks using logistic regression of the pooled data. The analysis sample included 137,218 women whose most recent live birth in the 5- year period before the survey took place in a health facility. Of this pooled sample, 65.7% of women were under 30 years of age, 85.9% were currently married, and 57% resided in rural areas. Across countries, the median percentage of women who reported receiving a check was 71.7%, ranging from 26.6% in Eswatini (Swaziland) to 94.4% in Burkina Faso. The most fully adjusted model showed that factors from all four conceptual categories (obstetric/neonatal risk factors, care environment, and women's sociodemographic and child-related characteristics) were significant determinants of receiving a check. Women with a cesarean section had a significantly higher adjusted odds ratio (aOR) of 1.88 (95% CI 1.72-2.05, p < 0.001) of receiving a check. Women giving birth in lower-level public facilities had lower odds of receiving a check (aOR 0.94, 95% CI 0.90-0.98, p = 0.002) compared to those in public hospitals, as did women attended by a nurse/midwife (compared to doctor/nonphysician clinician) (aOR 0.74, 95% CI 0.69-0.78, p < 0.001). This study was limited by the accuracy of the respondent's recall of the provider, timing, and receipt of postpartum checks. The outcome of interest was measured using three slightly different question sets across the 33 included countries. CONCLUSIONS: The suboptimal levels of postpartum checks in health facilities in many of the included SSA countries partially reflect the lack of importance given to postpartum care in the global discourse on essential interventions and quality improvement in maternal health. Addressing disparities in access to both facility-based childbirth and good-quality postpartum care in SSA is critical to addressing stalling declines in maternal mortality and morbidity